Content of training
The curriculum consists of three phases of learning:
These phases reflect:
- an early induction and basic grounding in public health;
- acquisition of the knowledge base;
- basic skills training;
- consolidation of core advanced skills;
- an option for registrar selected components which will allow development of defined interest or practice within a specified setting.
How long is each phase of training?
The three phases of learning are not defined by time but by successful acquisition of learning outcomes defined for each phase.
Learning outcomes are linked to a target phase of training; this is the latest phase by the end of which the competency should be evidenced. This does not preclude early achievement. However, many of the learning outcomes identified for phase 3 involve work of complexity for which experience and competence might accumulate over a longer period.
For some registrars it may be suitable for projects to satisfy/acquire learning outcomes in a higher phase of training with the agreement of their TPD. For example, whilst in phase 1 of training registrars could agree to undertake a project with associated learning outcomes which span into phase 2. However, it would not be appropriate for phase 3 learning outcomes to be achieved whilst registrars are in phase 1.
Progression between phases
Passage between phases is dependent on success both in examinations and in satisfactory workplace-based assessments.
The public health training pathway diagram [pdf] provides an overview of the public health specialty training programme.
Phase 1 combines early induction to training and introduction to basic core public health skills with acquisition of knowledge. The induction will include workplace and human resources policies and practice.
Phase 1 of training usually takes a maximum of two years, up to the time that the registrar can demonstrate a secure public health knowledge base (knows and knows how).
Academic study in phase 1
During phase 1 registrar's may attend a course of academic study which will run across one or two years. (The total period of time in phase 1 would normally allow one year full-time equivalent, in three university terms, on an academic course plus a further year in early service work. Registrars who take their academic course in a modular structure across two years would achieve the same service level experience across that period of time).
Academic courses combine face-to-face teaching with self directed learning and this is complemented by workplace-based experiential learning, putting into practice early knowledge.
Assessment during phase 1
This phase is assessed through the Part A MFPH examination, a two-part examination testing knowledge through short answer questions and ‘knows how' through critical appraisal and a practical written exercise of a real public health problem.
In addition, by the end of phase 1 registrars will achieve learning outcomes in standard situations (assessed in the service environment) for example:
- those which are complicated by the influence of at least two external factors;
- involve a small population which is relatively homogeneous in make up;
- involve simple issues (e.g. can be decided by a single manager);
- are demonstrated as part of a larger project led by others.
Work based discussion and an adaptation of the mini clinical exercise will be used to assess analytic and data handling skills.
Transition from phase 1 to phase 2 requires a pass at the examination for Part A MFPH and a satisfactory assessment in phase 1 learning outcomes in the workplace.
Phase 2 (typically 6-9 months) sees registrars begin to further develop their core public health skills (examined via the Part B MFPH examination) and basic practical competence, typically through clearly defined service work. This uses their knowledge base acquired in phase 1 and applies this in increasingly complex practical settings.
By the end of phase 2 registrars will achieve learning outcomes in more complex situations for example:
- those which are complicated by two or more external factors the influence of which is not completely defined;
- involve a population that has more complex make up, e.g. multiple age groups, social groups or ethnic groups;
- involve intermediate issues (require a committee or subcommittee to make a decision);
- are demonstrated where the registrar is making a significant contribution to a larger project led by others or leading a smaller project.
In this phase registrars will be expected to take the lead for simple areas of work and develop their skills of presentation and debate.
During phases 1 or 2 registrars will spend three months (wte) on an attachment to a health protection unit or in health protection work and, when assessed as competent, will start out of hours duties.
Out of hours experience does not begin until the knowledge base is secured, as evidenced through a pass at Part A MFPH and satisfactory local workplace-based assessment of knowledge of on-call procedures.
Assessment of phase 2
This phase of the programme is mainly delivered through workplace based experiential learning assessed through:
The end of this phase is completed after a satisfactory performance at the Part B MFPH examination and satisfactory assessment of phase 2 learning outcomes in the workplace.
The very nature of public health practice may mean that registrars may be gaining some phase 2 competencies during phase 1, when they may start to put into practice their expanding knowledge base in pieces of service based work.
Phase 3 allows the registrar to consolidate core skills in the practice of public health and to develop specific interests which will enhance career opportunities.
This phase of training typically lasts from 24-30 months: from the time the registrar passes the Part B MFPH examination until they are awarded their CCT.
During this phase registrars learn mainly by experiential learning with new advanced theoretical knowledge covered by formal courses and conferences, mainly at a national level (e.g. advanced critical appraisal skills, specialist health protection skills).
By the end of phase 3 registrars will achieve learning outcomes in complex situations for example:
This phase allows those registrars progressing well in training to select optional special interest learning outcomes to add to their core competence. These options will have been planned during phase 2 and through regular discussions between supervisor, registrar and programme director.
Some specialty registrars will choose to remain within a generalist public health setting and consolidate their core skills.
Time out of programme, for example for Walport (or equivalent) academic training or relevant experience abroad, may be possible.
Assessment of phase 3
This phase is assessed through multiple source feedback, work based discussion, direct observation of practice, structured assessment of components of daily public health practice (mini CEX) and the registrar's portfolio of work.
Satisfactory completion of training is not simply a signing off of individual learning outcomes but will also require evidence both of experience of several settings as the context for competence and of integration of competencies to evidence performance at consultant level.
During phase 1 or 2 the trainee must undertake a three-month attachment (or equivalent period) to a health protection unit or consultant in communicable disease control, where they are expected to acquire many of the public health skills to deal with health protection issues
Guidance documents on health protection attachment
Below is a series of guidance documents describing the general training requirements in health protection for all trainees and the higher level of training for those trainees who wish to specialise in Health Protection.
- The FPH and the HPA approved Health Protection Training for generalists in public health, including Educational Requirements for on-call [pdf] in August 2006.
- Training in Health Protection [pdf] June 2003
The guidance recognises the wider specialism of health protection that was announced in Getting Ahead of the Curve.
- Standards and guidance for commencement of supervised on call duties [pdf] May 2007
This document describes the standards required of all trainees in public health to be achieved before starting supervised on-call duties. It also gives guidance to trainers on possible methods of delivery for development of competence for on-call and for assessment of competence.
Although communicable disease control is not a sub-speciality of public health, those interested in training to become a consultant in communicable disease control should make their interest known as soon as possible to their Faculty Adviser, who may refer them to a local CCDC trainer for further advice.
A log of health protection activity should be maintained by the trainee via a logbook.
Trainees expressing interest in developing special interests and who move onto this path of phase 3 training will be able to achieve additional optional special interest learning outcomes (OSILOs) in certain areas of the curriculum through trainee-selected special interest options and experience specialist settings while also consolidating their more advanced core competence.
The key areas within which competence may be taken beyond the core training requirements are:
- Health improvement (Key Area 5).
- Health protection (Key Area 6).
- Health and social service quality (Key Area 7).
- Public health information and intelligence (Key Area 8).
- Academic public health (Key Area 9).
The curriculum also recognises that some learning goals for highly specialised practice and experience in very specialist settings may need to be fulfilled through professional development beyond CCT.
Specialty training should equip registrars to work as public health consultants. Once registrars have completed training they should have the skills and knowledge to:
- Quantitatively and qualitatively assess the population's health and heath needs, including managing, analysing, interpreting, and communicating information that relates to the determinants and status of health and well-being and allows development of effective action.
- Critically assess the evidence relating to the effectiveness of health and healthcare interventions, programmes and services, apply this to practice and improve services and interventions through audit and evaluation.
- Influence the development of policies, implement strategies to put the policies into effect and assess the impact of policies on health.
- Lead teams and individuals, build alliances, develop capacity and capability, work in partnership with other practitioners and agencies and effectively use the media to improve health and wellbeing.
- Promote the health of populations by influencing lifestyle and socio-economic, physical and cultural environment through methods of health promotion, including health education, directed towards populations, communities and individuals.
- Protect the public's health from communicable and environmental hazards by application of a range of methods including hazard identification, risk assessment and the promotion and implementation of appropriate interventions.
- Support commissioning, clinical governance, quality improvement, patient safety, equity of service provision and prioritisation of health and social care services.
- Collect, generate, synthesise, appraise, analyse, interpret and communicate intelligence that measures the health status, risks, needs and health outcomes of defined populations.
- Teach and research in public health.
Public health skills are built on a knowledge base which is detailed in the MFPH Part A syllabus, including:
- Basic and clinical sciences including research method, epidemiological and statistical method, health needs assessment and evaluative technique.
- Disease causation and prevention including health promotion, screening, communicable disease and environmental hazard control and social politics.
- Organisation and delivery of health care, including health intelligence.
- Knowledge of the law as it affects the population's health.
- Leadership and management skills including change management and health economics.
This knowledge base has been mapped to the nine key areas of public health practice and every learning outcome has a clearly identified knowledge base (other than those which define attitudes and behaviours).
Registrars may attend a formal academic course or prepare for the examination under their own direction.
The Part A MFPH examination is held twice yearly, in January and June. Registrars would normally be expected to sit this examination at the earliest opportunity depending on the length of their academic course.